title: Triple-layer duct-to-mucosa pancreaticojejunostomy with resection of jejunal serosa decreased pancreatic fistula after pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreatic fistula (PF) is one of the most common complications after pancreaticoduodenectomy (PD). We described a new method of pancreaticojejunostomy (PJ) developed by combining triple-layer duct-to-mucosa PJ with resection of jejunal serosa, which was named as modified layer-to-layer PJ (MLLPJ). The aim of the present study was to observe whether the new technique would effectively reduce the PF rate in comparison with two-layer duct-to-mucosa PJ (TLPJ).
  
  
  METHODS
  Data on 184 consecutive patients who underwent the two methods of PJ after standard PD between January 1, 2010 and January 31, 2013 were collected retrospectively from a prospective database. The primary endpoint was the PF rate. The risk factors of PF were investigated by using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 88 patients received TLPJ and 96 underwent MLLPJ. Rate of PF for the entire cohort was 8.2%. There were 11 fistulas (12.5%) in the TLPJ group and four fistulas (4.2%) in the MLLPJ group (P = 0.039). Body mass index, pancreatic texture, pancreatic duct diameter, and methods of PJ anastomosis had significant effects on the formation of PF on univariate analysis. Multivariate analysis showed that pancreatic duct diameter ≤3 mm and TLPJ were the significant risk factors of PF.
  
  
  CONCLUSIONS
  MLLPJ effectively reduces the PF rate after PD in comparison with TLPJ. Results confirm increased PF rates in patients with pancreatic duct diameter ≤3 mm compared with pancreatic duct diameter >3 mm.
authors.affiliation: Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: An-Ping
authors.initials: AP
authors.lastname: Su
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Neng-Wen
authors.initials: NW
authors.lastname: Ke
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Lu
authors.forename: Bo-Le
authors.initials: BL
authors.lastname: Tian
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Hu
authors.forename: Zhao-Da
authors.initials: ZD
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Duct to mucosa; Layer to layer; Pancreaticoduodenectomy; Pancreaticojejunostomy; Resection of jejunal serosa